KEY ROLES AND RESPONSIBILITIES
Care Management
Manning calls on the 24-hour medical emergencies help lines
Facilitate approval and authorisation for Emergency Inpatient hospitalisation e.g. post road traffic accidents from the insurance companies/underwriters.
Outpatient treatment authorisation (off smart/ no card)
Facilitate evacuation processes to ensure favourable outcomes and reasonable charge to clients.
Preauthorization request processing and hospital procedure booking including maternity and theatre procedure bookings.
Liaising with the Insurance companies in the process of undertaking and pre-authorizations.
Provider panel management - ensuring required facilities are onboarded and favourable relationship is always maintained.
Advocating for clients
Negotiation of borderline claims
Support with overseas referral
Offer dedicated services to clients at their premises.
Reporting
Provide data reports collected from various monitoring tools assigned to the role e.g. weekly and/or monthly reports.
Trend analysis - hospital charges, cost of various packages etc
Value Adds
Facilitation of admission and discharge processes for patients by securing all necessary documents and ensuring minimal participation by the patient during the admission or discharge.
Facilitation of special care for admitted patients e.g haircuts for executive clients at the bed side/ flowers.
Issuing Zamara gift packs - pack of diapers, branded get well / birth congratulations to admitted patients.
SKILLS AND QUALIFICATIONS
A Diploma in Nursing Sciences/ Clinical medicine
Minimum of one (1) year working in a hospital set up/ health facility/medical insurance care department
General understanding of the insurance industry is an added advantage.
Capacity to build relationships
Business etiquette
Excellent interpersonal and customer service skills
Team player
Problem Solving skills
Self-Driven
Flexible to train